急性肺损伤和急性呼吸窘迫综合征的诊断与治疗  

Recent progress in research on the diagnosis and treatment of acute lung injury and acute respiratory distress syndrome

作　　者：钱桂生[1] 

机构地区：[1]第三军医大学新桥医院全军呼吸内科研究所,重庆400037

出　　处：《解放军医学杂志》2009年第4期371-373,共3页Medical Journal of Chinese People's Liberation Army

基　　金：国家自然科学基金资助项目(30770928);军队"十一五"攻关课题(06G083);重庆市自然科学基金资助项目(2007BB5072);第三军医大学科研基金资助项目(2006HG04)

摘　　要：急性肺损伤和急性呼吸窘迫综合征是临床常见的急危重症,其发病机制尚未完全阐明。由于缺乏早期、敏感的诊断指标,且无特异、有效的治疗措施,所以急性肺损伤的病死率高。在疾病诊断方面,虽然理论上可以从发病机制及损伤靶点着手,寻找诊断标志物及治疗靶点,但迄今为止仍未找到一种敏感性及特异性均较好的早期诊断标志物。弥漫性肺泡损伤是急性肺损伤的主要病理特点,也是诊断的可靠标准,但由于在患者生前取肺组织较困难,所以结合临床动态监测动脉血气仍是目前早期发现急性肺损伤的主要措施。在疾病治疗方面,针对炎症失控而采用的激素治疗并未取得良好疗效,所以目前不主张常规使用;但对过敏、误吸等因素导致的急性肺损伤,可以考虑早期、短期、适量使用。在治疗原发病的基础上,采用多靶点综合治疗和纠正缺氧是治疗急性肺损伤的主要措施。机械通气是纠正缺氧的最主要的呼吸功能替代疗法,在使用时,应采用小潮气量肺保护性通气策略及加用适度呼气末正压(PEEP)。总之,从炎症失控、弥漫性肺泡损伤着手去寻找早期诊断方法及治疗措施仍是今后研究的重点。Acute lung injury （ALI） and acute respiratory distress syndrome （ARDS） are commonly encountered serious diseases. The pathogenesis of Aid and ARDS remains unclear at present. The mortality rate of ALl and ARDS remains high due to the absence of sensitive method for early diagnosis and specific and effective therapy. The present paper will focus on the latest developments of diagnosis and treatment for ALI and ARDS. Diagnosis： Althongh theoretically it is possible to look for the diagnostic markers and target of injury by painstaking study of its pathogenesis, but as yet an ideal pathognomonic rmrker with due sensitivity and specificity remains unavailable. Diffuse alveolar injury is a major pathological feature and may act as a reliable parameter for the diagnosis of ALI and ARDS. However, it is difficult to obtain the lung tissues from living patients with ALI/ARDS, mad dynamic monitoring of arterial blood gas, combined with clinical symptoms, is still the main criterion for early diagnosis of API and ARDS in clinical setting. Therapy： The use of corticostemids to subdue rampant inflammatory reaction had not given a promising result in clinical study, so it is not recommended for routine use, however short-term corticosteroids may be considered for allergy- or aspiration-induced ALl in early stage. With the treatment of primary diseases as the main strategy, the main therapeutic measures for ALI/ARDS should be integrated treatment of multiple targets and correction of hy poxia. Mechanical ventilation is the main substitutive therapy for correction of hypoxia. Protective ventilation with adequate tidal volume and positive end-expiratory pressure （PEEP） are recommended. Briefly, management of primary disease, correct use of mechanical ventila- tion, nutritional support and specific treatment for pathological changes and clinical manifestation are important for ALI and ARDS pa tients. Hereafter, emphasis should be placed on seeking the methods for early diagnosis and effective therapies for diffuse

关 键 词：生物医学研究 急性呼吸窘迫综合征 成人 诊断 治疗 

分 类 号：R563.9[医药卫生—呼吸系统]